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Wanting to make 1M+ per year on first year out of residency

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Psychdoc4755

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Before anyone asks, I have many dependents and tons of life responsibility outside of medicine so I am willing to push myself to help the people I love.

I've already been offered $290 per hour to work at a facility in Wyoming as an inpatient psychiatrist. I can easily work about 80 hours per week, possibly 90-100 on a very tough week, so let's average 85 hours per week working every week out of the year coming out to 52 x 85 x 290 = 1.28 million per year.

Is this realistic? Or would I be smarter to work in a more populated area and strike deals/contracts with hospitals with lack of psychiatric coverage to join on as an employee and be able to round on and bill individually for multiple 50+ patient units. Also, I'm considering nursing homes. Is this lucrative?

I have a significant other with severe debt and would like to help her out and my dependents as much as possible. Thank you for your help

And please don't mention that I'm going to get burned out. I know plenty of doctors and people from other professions who can work hours like that and be fine. Those rules don't apply to everybody and I am confident in my ability to stay focused and stay on task at all times.
 
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clausewitz2

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Before anyone asks, I have many dependents and tons of life responsibility outside of medicine so I am willing to push myself to help the people I love.

I've already been offered $290 per hour to work at a facility in Wyoming as an inpatient psychiatrist. I can easily work about 80 hours per week, possibly 90-100 on a very tough week, so let's average 85 hours per week working every week out of the year coming out to 52 x 85 x 290 = 1.28 million per year.

Is this realistic? Or would I be smarter to work in a more populated area and strike deals/contracts with hospitals with lack of psychiatric coverage to join on as an employee and be able to round on and bill individually for multiple 50+ patient units. Also, I'm considering nursing homes. Is this lucrative?

I have a significant other with severe debt and would like to help her out and my dependents as much as possible. Thank you for your help

And please don't mention that I'm going to get burned out. I know plenty of doctors and people from other professions who can work hours like that and be fine. Those rules don't apply to everybody and I am confident in my ability to stay focused and stay on task at all times.

So I get they are offering you $290 per hour, but are they actually cool with you billing them 85 hours a week? They may be able to offer this rate precisely because they are not expecting much beyond normal full-time, if that.
 
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zolof

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So I get they are offering you $290 per hour, but are they actually cool with you billing them 85 hours a week? They may be able to offer this rate precisely because they are not expecting much beyond normal full-time, if that.

Advertisements for jobs are one thing but in the real world this is in fact the closest to reality. overhwlming majority of high paying locums, shoot even low paying locums, are capped ...
 
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psyguru

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Before anyone asks, I have many dependents and tons of life responsibility outside of medicine so I am willing to push myself to help the people I love.

I've already been offered $290 per hour to work at a facility in Wyoming as an inpatient psychiatrist. I can easily work about 80 hours per week, possibly 90-100 on a very tough week, so let's average 85 hours per week working every week out of the year coming out to 52 x 85 x 290 = 1.28 million per year.

Is this realistic? Or would I be smarter to work in a more populated area and strike deals/contracts with hospitals with lack of psychiatric coverage to join on as an employee and be able to round on and bill individually for multiple 50+ patient units. Also, I'm considering nursing homes. Is this lucrative?

I have a significant other with severe debt and would like to help her out and my dependents as much as possible. Thank you for your help

And please don't mention that I'm going to get burned out. I know plenty of doctors and people from other professions who can work hours like that and be fine. Those rules don't apply to everybody and I am confident in my ability to stay focused and stay on task at all times.
Why not do expert witness work at almost double that (even more to testify). How about creating a business and having passive income streams. I am not sure what you propose is sustainable. I would join some of the FB groups. It would be more sustainable to have a variety of non-clinical revenue streams and passive income. currently, I only do clinical work 3 days a week. I do enjoy those multi-day testimony assignments (testify for 1 hour/ prep for a few hours but invoice 24 or more hours at about 3x your hourly). as an expert witness you even invoice the time traveling (which is maybe $50 less than your hourly), time spent chit chatting with attorneys and reading records and writing the reports. a lot better than having to see 50 patients a day. my next goal is to develop some passive income streams (managing an expert witness panel and telepsych business).

90% of the work can be done at home casually in your boxers or briefs.

If you were to do 10 capital mitigation cases, that would be a million (each one is 200 hours/ 100k...50 hours a week...take two full months off).
Malboro/Philip Morris cases go for 50-60 k a pop (plus your soul).

All the income goes to me and not a hospital executive or insurance CEO. I have some costs but don't have to rent an office or have full time staff.

I think you could find ways of working smarter but not harder.
 
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Sushirolls

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Remember, units typically have the main staff working during the day. That means the unit secretary, social workers, and higher nursing ratios are all for the day time, and they are there to help facilitate the discharge process. Patients are also awake during the day. If you are looking to round extra early or extra late, there is less staff to facilitate the actual discharge, or well the patients are asleep.

So other external factors may limit the big rounding plans.
 
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bber54

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Why not do expert witness work at almost double that (even more to testify). How about creating a business and having passive income streams. I am not sure what you propose is sustainable. I would join some of the FB groups. It would be more sustainable to have a variety of non-clinical revenue streams and passive income. currently, I only do clinical work 3 days a week. I do enjoy those multi-day testimony assignments (testify for 1 hour/ prep for a few hours but invoice 24 or more hours at about 3x your hourly). as an expert witness you even invoice the time traveling (which is maybe $50 less than your hourly), time spent chit chatting with attorneys and reading records and writing the reports. a lot better than having to see 50 patients a day. my next goal is to develop some passive income streams (managing an expert witness panel and telepsych business).

90% of the work can be done at home casually in your boxers or briefs.

If you were to do 10 capital mitigation cases, that would be a million (each one is 200 hours/ 100k...50 hours a week...take two full months off).
Malboro/Philip Morris cases go for 50-60 k a pop (plus your soul).

All the income goes to me and not a hospital executive or insurance CEO. I have some costs but don't have to rent an office or have full time staff.

I think you could find ways of working smarter but not harder.

How does one get into this line of work? Through forensic psychiatry?
 

CalmAndCollected

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Before anyone asks, I have many dependents and tons of life responsibility outside of medicine so I am willing to push myself to help the people I love.

I've already been offered $290 per hour to work at a facility in Wyoming as an inpatient psychiatrist. I can easily work about 80 hours per week, possibly 90-100 on a very tough week, so let's average 85 hours per week working every week out of the year coming out to 52 x 85 x 290 = 1.28 million per year.

Is this realistic? Or would I be smarter to work in a more populated area and strike deals/contracts with hospitals with lack of psychiatric coverage to join on as an employee and be able to round on and bill individually for multiple 50+ patient units. Also, I'm considering nursing homes. Is this lucrative?

I have a significant other with severe debt and would like to help her out and my dependents as much as possible. Thank you for your help

And please don't mention that I'm going to get burned out. I know plenty of doctors and people from other professions who can work hours like that and be fine. Those rules don't apply to everybody and I am confident in my ability to stay focused and stay on task at all times.
Alternatively, why not take the majority of your profits through more reasonable hours and invest them?
 
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m2k

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Before anyone asks, I have many dependents and tons of life responsibility outside of medicine so I am willing to push myself to help the people I love.

I've already been offered $290 per hour to work at a facility in Wyoming as an inpatient psychiatrist. I can easily work about 80 hours per week, possibly 90-100 on a very tough week, so let's average 85 hours per week working every week out of the year coming out to 52 x 85 x 290 = 1.28 million per year.

Is this realistic? Or would I be smarter to work in a more populated area and strike deals/contracts with hospitals with lack of psychiatric coverage to join on as an employee and be able to round on and bill individually for multiple 50+ patient units. Also, I'm considering nursing homes. Is this lucrative?

I have a significant other with severe debt and would like to help her out and my dependents as much as possible. Thank you for your help

And please don't mention that I'm going to get burned out. I know plenty of doctors and people from other professions who can work hours like that and be fine. Those rules don't apply to everybody and I am confident in my ability to stay focused and stay on task at all times.

How many hours are they're guaranteeing you per week/month/year.
Maybe someone can comment on this, but to me it is exceptionally high rate if they can offer 40 hours per week guarantee for whole year.
 

Psychdoc4755

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Again, what one agency “offers” regarding hours/workload is irrelevant. You can accept multiple gigs from different locations.

And regarding what sushirolls said, there are certainly examples of psychiatrists who round on multiple units daily. I’m sure there is a way to coordinate this especially if the units are desperate enough.
 

psyguru

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How does one get into this line of work? Through forensic psychiatry?
Although forensic psychiatry experience/ certification/ training allows for the greatest variety in cases (more than other fields), it is worth noting that many medical experts/ Independent Medical Examiners are in fields that have no Forensic subspecialization. The "Forensic" fields include Forensic Dentistry, Forensic Pathology, Forensic Psychiatry and maybe even Occupational Medicine (i.e. Fitness for Duty...I know it is a stretch to include this). You could get some training via www.seak.com and get an ABIME (certification for performing IMEs). I also saw one addiction expert get some other Forensic organization certification. In his deposition, he said he was qualified to opine in non-criminal cases. As only 3% of psychiatrists are forensic psychiatrists, there may be some middle-of-nowhere jurisdictions with some old-timer churning out misdemeanor competency to stand trial evaluations for under 2 k (not my cup of tea). Many judges may not bother checking if they meet the statutory requirements.

I would recommend starting off with IMEs that is simple and unlikely to result in litigation. For example simple Fitness for Duty or short-term Disability (I am not too familiar with the AMA Impairment Ratings). Without forensic certification or marketing savvy/confidence, perhaps you could net 3-4 k for the evaluations, record review, and report. Also perhaps you could do some Proabate type of work. As a clinician, I would fill out the guardianship form for...free. As a forensic psychiatrist, I charged about 3k (simple form plus one-page addendum, no fancy report). However, it was the most comprehensive guardianship form I ever did. Medical malpractice can also be done.

If you are specialized you may be able to do more. A geriatric psychiatrist is maybe able to do will contests. Child psychiatrists could do custody perhaps.

Feel free to PM me. I know a company that mentors general psychiatrists and provides referrals for expert witness and IME work.
 

m2k

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Can someone please she how common is $290 per hour and consistently getting 40 hours/week for the whole year. I'm genuinely interested if this is so lucrative and should choose this profession.
 

Psychdoc4755

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It’s not a matter of one facility offering you 40 hours for the whole year. You take 20 hours here, 20 patients there, 30 hours here, suboxone clinic there, locums here, outpatient there, telepsych here. Tons of opportunity. You will never be limited by number of hours any facility/job is offering you
 
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BiscoDisco

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Doesn't shufflin work multiple units and pull in big (albeit not 1M a year) income? From what I recall he has a pretty great set up. In residency we round on the inpatient unit starting at 630 some mornings. Rounds are done by 11ish. If I were an attending, it doesn't seem unrealistic to eat lunch then drive across town and round from 1-530ish at another unit. Is this really not doable as some are implying?
 
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allantois

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Jesus. How?

Wouldn't this be something like 10k+ a day in billings? That'd be like 3M a year...that surely must draw some red flags from someone, somewhere..?

It was basically all Medicaid patients. 5 mins appointments, if not less. One doc would just line the patients outside of his door and wouldn’t even chart much of anything beyond copying the past notes over and over. I’m not sure if they kept all of the collections as they were employed by a facility in Florida. I guess government is too busy going after pill mills, to pay attention to anything else
 
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BiscoDisco

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It was basically all Medicaid patients. 5 mins appointments, if not less. One doc would just line the patients outside of his door and wouldn’t even chart much of anything beyond copying the past notes over and over. I’m not sure if they kept all of the collections as they were employed by a facility in Florida. I guess government is too busy going after pill mills, to pay attention to anything else

On the flip side I wonder if this is better than no doc/meds at all?
 
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sluox

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To OP:

this is very uncommon, mostly due to logistic reasons (as someone said, few facilities are willing to pay one locum 1M a year, as this is very unstable--you pull out all of a sudden 1M worth of work is unstaffed, and the facility is screwed. They'd much prefer to have a cadre of 5 locums each working 200k for stability and, possibly, cross-coverage. If you are willing and the facility doesnt care the fell free!

Perhaps you can find multiple locums at different facilities, but this requires a larger market. In large cities, it's not easy to find $290 an hour locum. Typically you have a full-time job which pays 250k + locum which pays another 250k (at most), which yields 500k. This usually takes 60-80 hours a week and kills most of your weekends. One night shift is typically $2000, and you do two shifts every week/ weekend. Something like that.

That said--this is not terribly different from the lifestyle (in every facet) of a say cardiologist who takes q4 in house call or something.

Most dominant paradigm of psychiatrists getting paid > 750k a year is high-end private practice in top markets. Second is a business owner operating a moderately large practice with numerous employed NPs/PhDs. Neither of these two prototypes require 80 hours a week. However, neither is easy to get.
 
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Psychresy

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To OP:

this is very uncommon, mostly due to logistic reasons (as someone said, few facilities are willing to pay one locum 1M a year, as this is very unstable--you pull out all of a sudden 1M worth of work is unstaffed, and the facility is screwed. They'd much prefer to have a cadre of 5 locums each working 200k for stability and, possibly, cross-coverage. If you are willing and the facility doesnt care the fell free!

Perhaps you can find multiple locums at different facilities, but this requires a larger market. In large cities, it's not easy to find $290 an hour locum. Typically you have a full-time job which pays 250k + locum which pays another 250k (at most), which yields 500k. This usually takes 60-80 hours a week and kills most of your weekends. One night shift is typically $2000, and you do two shifts every week/ weekend. Something like that.

That said--this is not terribly different from the lifestyle (in every facet) of a say cardiologist who takes q4 in house call or something.

Most dominant paradigm of psychiatrists getting paid > 750k a year is high-end private practice in top markets. Second is a business owner operating a moderately large practice with numerous employed NPs/PhDs. Neither of these two prototypes require 80 hours a week. However, neither is easy to get.

I do however see corrections hourly rates routinely in the 240-320 range, almost always looking for full time staffing. In your experience, are the corrections rates typically higher or are the rates I'm seeing also atypical?

And when you say night shift for 2k, are you referring to in house coverage or at home availability by phone for an inpatient unit?
 

sluox

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I do however see corrections hourly rates routinely in the 240-320 range, almost always looking for full time staffing. In your experience, are the corrections rates typically higher or are the rates I'm seeing also atypical?

And when you say night shift for 2k, are you referring to in house coverage or at home availability by phone for an inpatient unit?

corrections hourly IS typically higher. However, even in that case, I suspect few prisons would pay you 1M to staff everything. They usually don't want to have one full time + locums and no one else. I've never heard of that person. It's not atypical to have 500k total income (esp. 1099) to cover corrections/state hospitals--but then it's no longer logistically feasible to staff other locums, as these locations are usually very out of the way. OTOH, in many states, the top paid public servant is a correctionals psychiatrist with overtime, and this is all public knowledge and searchable--many of those are paid more than the governor.

2-2.5k per shift (12 hours) is usually in house. Home calls are cheaper and not necessarily less demanding.
 
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Psychresy

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corrections hourly IS typically higher. However, even in that case, I suspect few prisons would pay you 1M to staff everything. They usually don't want to have one full time + locums and no one else. I've never heard of that person. It's not atypical to have 500k total income (esp. 1099) to cover corrections/state hospitals--but then it's no longer logistically feasible to staff other locums, as these locations are usually very out of the way. OTOH, in many states, the top paid public servant is a correctionals psychiatrist with overtime, and this is all public knowledge and searchable--many of those are paid more than the governor.

2-2.5k per shift (12 hours) is usually in house. Home calls are cheaper and not necessarily less demanding.

Gotcha. So pulling 300/hr at 40 hour weeks at a prison, then tacking on a weekend or overnight coverage a few times a month should get you to that 700k ish range. More work than I would ever want to do, but for OP or anyone who is super money motivated, doesn't seem that difficult. 4 x10s and a few overnight shifts a month....not bad at all.
 

sluox

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Gotcha. So pulling 300/hr at 40 hour weeks at a prison, then tacking on a weekend or overnight coverage a few times a month should get you to that 700k ish range. More work than I would ever want to do, but for OP or anyone who is super money motivated, doesn't seem that difficult. 4 x10s and a few overnight shifts a month....not bad at all.

Yeah this is probably the upper limit of facility services driven income. It'll not get over 1M a year.

Still--whether a fresh grad might be able to 1. get this combination 2. implement it, is highly suspect. Many of the "cushier" correctionals jobs are actually somewhat selective and they want people with experience. One could imagine why... LOL. Often they also want a commitment/payback.

I find the idea of doing 40 solid hours of correctionals work PLUS every weekend of inpatient absolutely intolerable. But to each his own. And, is this lifestyle really worse than working as a mid-level investment banker/corporate lawyer making a similar amount? Not sure. Maybe not. LOL
 
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Psychresy

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Yeah this is probably the upper limit of facility services driven income. It'll not get over 1M a year.

I find the idea of doing 40 solid hours of correctionals work PLUS every weekend of inpatient absolutely intolerable. But to each his own. And, is this lifestyle really worse than working as a mid-level investment banker/corporate lawyer making a similar amount? Not sure. Maybe not. LOL

I think 40 hours of corrections + maybe one weekend a month wouldn't be that terrible. Definitely FAR FAR FAR better than the ibankers or big law lawyers who work 70-80 hours a week, every week.

Also worth considering...if living/practicing in a state with high income tax is the difference between 700k vs 1M really that big of a difference when accounting for taxes? Didn't crunch the numbers, but I'd venture to guess it's MAYBE an extra 7-9k a month after tax. Nothing to sneeze at, but when you're making that kind of money, I would think time off becomes more important than a couple extra thousand in the bank account each week.
 

sluox

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I think 40 hours of corrections + maybe one weekend a month wouldn't be that terrible. Definitely FAR FAR FAR better than the ibankers or big law lawyers who work 70-80 hours a week, every week.

Also worth considering...if living/practicing in a state with high income tax is the difference between 700k vs 1M really that big of a difference when accounting for taxes? Didn't crunch the numbers, but I'd venture to guess it's MAYBE an extra 7-9k a month after tax. Nothing to sneeze at, but when you're making that kind of money, I would think time off becomes more important than a couple extra thousand in the bank account each week.

To get to 750k you need 40 full hours of correctionals on 1099 plus 2 FULL weekends of work (i.e. in house for 4 shifts), which means you'll work nonstop for 7+5 days for every two week cycle, with a 4 week holiday. This seems somewhat doable, actually... now that I'm thinking about it... it's definitely not *the* worst.

This makes sense. I've heard about 10 years ago correctionals people were pulling half a mil at the time, which would now inflate to 750k.

I've made your second point many times on this forum but people, in general, don't listen and don't really understand. If you make 700k-1M, it's much better to be 1099 and pay yourself a lower salary and use the excess cash to invest in future passive income streams--this is true even before the Trump tax cut, and is indeed the intention of the law--the government incentivizes you to use the money you make to GROW your business. In particular, Trump tax cut implies it's immediately better year by year to keep most of the excess profit as corp profit/invest than receive it in personal income--and if you need to use it (to "take care of family memebers with a huge debt") then give yourself a loan--this is what my accountant recommended. Living outside of the high tax states would save you 10%+ (i.e. ~100k).
 
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oldiebutgoodie1211

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I've made your second point many times on this forum but people, in general, don't listen and don't really understand. If you make 700k-1M, it's much better to be 1099 and pay yourself a lower salary and use the excess cash to invest in future passive income streams--this is true even before the Trump tax cut, and is indeed the intention of the law--the government incentivizes you to use the money you make to GROW your business. In particular, Trump tax cut implies it's immediately better year by year to keep most of the excess profit as corp profit/invest than receive it in personal income--and if you need to use it (to "take care of family memebers with a huge debt") then give yourself a loan--this is what my accountant recommended. Living outside of the high tax states would save you 10%+ (i.e. ~100k).

so if one makes 500k, you’re saying they can pay themselves 100k and only pay taxes on that, then use the 400k to buy real estate with no taxes as a 1099?
 

Psychdoc4755

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Look up David Cotton. He is ~70 year old OB/Gyn doctor with net worth of about 3 billion. Started a medicaid only practice about 20 years ago in his 50s and sold to a larger healthcare organization a few years ago. I thought everyone on this forum was saying that medicaid practice is non-lucrative? This guy made 3 billion. What's to say a psychiatrist or other specialty can't do that as well?

I'm not trying to name names. But there seems to be a significant amount of misinformation on this forum regarding what you can and can't do and what you can and can't make as a practicing psychiatrist.

I see psych currently as the most underrated specialty in all of medicine. It's not nearly as competitive as it should be (should honestly be ROAD) for 2 reasons:
1. Med students perceive it as "lesser" specialty because it is "psych" and not a real doctor and there could be some family pressures there. So they don't even take the time to research it
2. Salary surveys are largely skewed. Totally unreliable. There's lots of room for significant payment in this field based on how you practice. And for only 4 years of residency with no real requirement to fellowship? It's not a bad deal - on par with derm. On that note, you gotta realize that the average psychiatrist is probably in his 50s/60s and at the end of his career and working part-time so that is what brings the income reports down.

There was a guy on whitecoatinvestor I was just reading about who made over 1M in his first year out of psychiatry residency. But of course, he was hustling like crazy. Personally, I've never heard of being to do that in any other specialty. Even the competitive ones.
 
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sluox

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so if one makes 500k, you’re saying they can pay themselves 100k and only pay taxes on that, then use the 400k to buy real estate with no taxes as a 1099?

I'm not an accountant or a lawyer, but one might imagine the following would be legal:
You make 500k in 1099, pay yourself a salary that's reasonable (say 200k), then use the rest to buy an office which you use as part of your business. The portion of the mortgage interest would be deductible from corporate tax. The rest would be taxed as business income, which has a much lower rate (and flat).
 
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oldiebutgoodie1211

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I'm not an accountant or a lawyer, but one might imagine the following would be legal:
You make 500k in 1099, pay yourself a salary that's reasonable (say 200k), then use the rest to buy an office which you use as part of your business. The portion of the mortgage interest would be deductible from corporate tax.

can I use the 300k to buy single family homes? Or does it have to be medically related
 

sluox

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can I use the 300k to buy single family homes? Or does it have to be medically related

Depends on what you use the single-family homes FOR. Are you planning on using them as a detox facility? Then probably. Is this close enough to your inpatient duties. You are playing with fire--I would consult a lawyer. It hinges on the definition of "business relatedness".

Now, that said, excess capital can easily be kept and invested as long as you pay taxes on it. That part doesn't have to be "business related"
 

sluox

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I'm no expert but I'm fairly certain you need to pay yourself an average salary to avoid audit.

According to my now much more aggressive accountant, there's a high degree of flexibility in terms of what is and isn't "average" salary. These things require professional input. If your tax is prepared by an accountant and you keep good record, even if you do get audited, which for those who make 1M+ occurs on a regular basis, it's fine.

In particular, a C-corp that has > 1M yearly revenue probably would need self-auditing anyway. This is not an extraordinary cost, a few thousand at most, especially if you have zero employees.
 
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deleted480308

Before anyone asks, I have many dependents and tons of life responsibility outside of medicine so I am willing to push myself to help the people I love.

I've already been offered $290 per hour to work at a facility in Wyoming as an inpatient psychiatrist. I can easily work about 80 hours per week, possibly 90-100 on a very tough week, so let's average 85 hours per week working every week out of the year coming out to 52 x 85 x 290 = 1.28 million per year.

Is this realistic? Or would I be smarter to work in a more populated area and strike deals/contracts with hospitals with lack of psychiatric coverage to join on as an employee and be able to round on and bill individually for multiple 50+ patient units. Also, I'm considering nursing homes. Is this lucrative?

I have a significant other with severe debt and would like to help her out and my dependents as much as possible. Thank you for your help

And please don't mention that I'm going to get burned out. I know plenty of doctors and people from other professions who can work hours like that and be fine. Those rules don't apply to everybody and I am confident in my ability to stay focused and stay on task at all times.
No one has $1mil a year in family responsibilities. If you just want money, that’s fine but be real about your reasons
 
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